=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710583448
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBER DAWN EDWARDS PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2020
-----------------------------------------------------
Last Update Date | 09/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16645 BIRKDALE COMMONS PKWY STE 100A
-----------------------------------------------------
City | HUNTERSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28078-5669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-863-4878
-----------------------------------------------------
Fax | 704-801-1391
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6102 FIRETHORNE LN
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28025-9117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-454-9484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------